Assessing causality between osteoarthritis and gastrointestinal disorders: a Mendelian randomization study.

The association between osteoarthritis (OA) and gastrointestinal disorders was found in observational studies. However, the causality is still elusive. A bidirectional Mendelian randomization (MR) analysis using genome wide association studies data was conducted to assess the causal association between OA and gastrointestinal diseases [including peptic ulcer disease (PUD), gastroesophageal reflux disease (GORD), and inflammatory bowel disease (IBD)]. A two-step MR (TSMR) was conducted between OA, gastrointestinal diseases and drugs to explore the mediating effects of non-steroidal anti-inflammatory drugs (NSAIDs) and opioids use. We used multivariable MR (MVMR) analysis to further validate the impact of prescription history on diseases. Results had statistical significance at a Bonferroni corrected P-value below 0.008. We observed that genetically predicted OA had a significant positive association with GORD [odds ratio (OR) = 1.26, P = 5e-05], but not with PUD or IBD. Regarding the other direction, gastrointestinal disorders as exposure had a null association with OA. Using TSMR, OA patients tended to increase the use of NSAIDs (OR = 1.45, P = 0.001) and opioids (OR = 1.77, P = 2e-05), but only the use of opioids increased the risk of GORD (OR = 1.43, P = 5e-09). Further MVMR analysis showed that the adverse effect of OA on GORD was significantly reduced after adjusting for opioids use (OR = 1.20, P = 0.038). This study provides evidence for the causal association between OA and increased risk of GORD, which is partly attributed to opioids use in OA patients but not NSAIDs.

Assessment of the bidirectional causal association between frailty and depression: A Mendelian randomization study.

BACKGROUND: Observational studies have demonstrated a strong bidirectional association between frailty and depression, but it remains unclear whether this association reflects causality. This study aimed to examine the bidirectional causal relationship between frailty and depression. METHODS: Using genome-wide association study summary data, two-sample Mendelian randomization was performed to test for the potential bidirectional causality between frailty, as defined by both the frailty index and the frailty phenotype, and depression. Several frailty-related traits were additionally investigated, including weaker hand grip strength, slower walking pace and physical inactivity. Findings were replicated using an independent depression data source and verified using multiple sensitivity analyses. RESULTS: Genetically predicted higher frailty index (odds ratio [OR], 1.86; P < 0.001), higher frailty phenotype score (OR, 2.79; P < 0.001), lower grip strength (OR, 1.23; P = 0.003), slower walking pace (OR, 1.55; P = 0.027) and physical inactivity (OR, 1.44; P = 0.003) all were associated with a higher risk of depression. As for the reverse direction, genetic liability to depression showed consistent associations with a higher frailty index (beta, 0.167; P < 0.001) and a higher frailty phenotype score (beta, 0.067; P = 0.001), but not with other frailty-related traits that were investigated. The results were stable across sensitivity analyses and across depression datasets. CONCLUSIONS: Our findings add novel evidence supporting the bidirectional causal association between frailty and depression. Improving balance and muscle strength and increasing physical activity may be beneficial in both depression and frailty.

Systemic evaluation of the relationship between asthma and osteoarthritis: Evidence from a meta-analysis and Mendelian randomization study.

Objective: Osteoarthritis (OA) and asthma are two common chronic diseases with increasing incidence and prevalence, whereas there has been rare evidence to suggest the relationship between OA and asthma. This study aimed to analyze the causal relationship between OA and asthma. Methods: Existing studies of the relationship between asthma and OA published till July 18, 2023, were identified from PubMed and Web of Science databases for meta-analysis. Subsequently, the causal relationship of all and site-specific OA with asthma was explored through a bidirectional two-sample Mendelian randomization (MR) analysis. Results: A total of four eligible studies were included in the meta-analysis. In these studies, 80,550 participants were recruited, of whom 13,781 patients had OA. The asthma group had a significantly higher prevalence of OA than the control group (odds ratio (OR) = 2.08; 95% confidence intervals (CI): 1.42-3.03). However, MR analysis did not support a causal relationship between asthma and all OA and site-specific OA: knee and hip OA (OR = 1.03; 95% CI: 0.98-1.09), knee OA (OR = 1.02; 95% CI:0.96-1.08), and hip OA (OR = 1.04; 95% CI: 0.97-1.12). No causal relationship between OA and asthma was found through reverse MR analysis. Conclusions: This meta-analysis suggests that patients with asthma are likely to have a greater prevalence of OA. However, the result of MR analysis reveals that asthma does not have a causal relationship to all OA or site-specific OA.

Self-rated health, interviewer-rated health, and objective health, their changes and trajectories over time, and the risk of mortality in Chinese adults.

Background: Self-rated health (SRH), interviewer-rated health (IRH), and objective health reflect the overall health status from different aspects. This study aimed to investigate the associations of SRH, IRH, and objective health with mortality among Chinese older adults. Methods: This study used data from the 2008 (baseline), 2011, 2014 and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey. SRH and IRH were evaluated by questionnaire. Objective health was evaluated by the Chinese multimorbidity-weighted index (CMWI), which incorporated 14 diagnosed chronic diseases. SRH, IRH, and CMWI were assessed as: (1) baseline levels; (2) longitudinal changes by subtracting the values obtained in 2008 from the corresponding values in 2014; (3) trajectories by Group-Based Trajectory Modeling, respectively. The Cox proportional hazards model was used to explore the associations of baseline SRH, IRH, and CMWI, their changes, and trajectories with mortality. Results: A total of 13,800 participants were included at baseline (2008). The baseline SRH ([hazard ratio] 0.93, [95% confidence interval] 0.91-0.96), IRH (0.84, 0.81-0.87), and CMWI (0.99, 0.98-1.00) in 2008 were significantly associated with 10-year mortality (2008 to 2018). Among 3,610 participants, the changes of SRH (0.93, 0.87-0.98), IRH (0.77, 0.71-0.83), and CMWI (0.97, 0.95-0.99) from 2008 to 2014 were significantly associated with 4-year mortality (2014-2018). The trajectories were divided into "high SRH/IRH/CMWI" and "low and declining SRH/IRH/CMWI." Compared with "low and declining SRH/IRH/CMWI," "high SRH" (0.58, 0.48-0.70), "high IRH" (0.66, 0.55-0.80), and "high CMWI" (0.74, 0.61-0.89) from 2008 to 2014 were significantly associated with 4-year mortality (2014-2018). Conclusion: Baseline SRH, IRH, and CMWI, their changes and trajectories are all associated with mortality in Chinese older adults. It is possibly necessary to promote the use of cost-effective indicators in primary medical institutions to improve the health management of the older adults.

Associations of the Triglyceride and Glucose Index With Hypertension Stages, Phenotypes, and Their Progressions Among Middle-Aged and Older Chinese.

Objectives: To assess the associations of the triglyceride and glucose (TyG) index with hypertension stages, phenotypes, and their progressions. Methods: The data originated from the China Health and Retirement Longitudinal Study. Multinomial logistic regression investigated the associations of the TyG index with hypertension stages (stage 1, stage 2), phenotypes (isolated systolic hypertension [ISH], isolated diastolic hypertension [IDH], systolic diastolic hypertension [SDH]), their progressions. Results: Compared with the lowest quartile of TyG index, the highest quartile was associated with increased risks of stage 1 hypertension (OR 1.71, 95% CI 1.38-2.13), stage 2 (1.74, 1.27-2.38), ISH (1.66, 1.31-2.11), IDH (2.52, 1.26-5.05), and SDH (1.65, 1.23-2.23). Similar results were found when TyG index was a continuous variable. From 2011 to 2015, a higher baseline TyG index was associated with normotension to stage 1 (per-unit: 1.39, 1.16-1.65), normotension to ISH (per-unit: 1.28, 1.04-1.56), and normotension to IDH (per-unit: 1.94, 1.27-2.97). Conclusion: The TyG index was associated with different hypertension stages, phenotypes, their progressions, and could be served as a surrogate indicator for early hypertension management.

A Causal Atlas on Comorbidities in Idiopathic Pulmonary Fibrosis: A Bidirectional Mendelian Randomization Study.

BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is a fatal lung disease with a high burden of both pulmonary and extrapulmonary comorbidities. RESEARCH QUESTION: Do these comorbidities have causal relationships with IPF? STUDY DESIGN AND METHODS: We searched PubMed to pinpoint possible IPF-related comorbid conditions. Bidirectional Mendelian randomization (MR) was performed using summary statistics from the largest genome-wide association studies for these diseases to date in a two-sample setting. Findings were verified using multiple MR approaches under different model assumptions, replication datasets for IPF, and secondary phenotypes. RESULTS: A total of 22 comorbidities with genetic data available were included. Bidirectional MR analyses showed convincing evidence for two comorbidities and suggestive evidence for four comorbidities. Gastroesophageal reflux disease, VTE, and hypothyroidism were associated causally with an increased risk of IPF, whereas COPD was associated causally with a decreased risk of IPF. For the reverse direction, IPF showed causal associations with a higher risk of lung cancer, but a reduced risk of hypertension. Follow-up analyses of pulmonary function parameters and BP measures supported the causal effect of COPD on IPF and the causal effect of IPF on hypertension. INTERPRETATION: The present study suggested the causal associations between IPF and certain comorbidities from a genetic perspective. Further research is needed to understand the mechanisms of these associations.

Smoking, alcohol consumption, and frailty: A Mendelian randomization study.

Background: Tobacco smoking and alcohol consumption have been associated with frailty in observational studies. We sought to examine whether these associations reflect causality using the two-sample Mendelian randomization (MR) design. Methods: We used summary genome-wide association statistics for smoking initiation (N = 2,669,029), alcohol consumption (N = 2,428,851), and the frailty index (FI, N = 175,226) in participants of European ancestry. Both univariable and multivariable MR were performed to comprehensively evaluate the independent effects of smoking and alcohol consumption on the FI, accompanied by multiple sensitivity analyses. Results were verified using lifetime smoking and alcohol use disorder. Reverse direction MR was undertaken to assess the potential for reverse causation. Results: Genetic predisposition to smoking initiation was significantly associated with increased FI (univariable MR: ß = 0.345; 95% confidence interval [CI] = 0.316 to 0.374; p = 1.36E-113; multivariable MR: ß = 0.219; 95% CI = 0.197 to 0.241; p = 2.44E-83). Genetically predicted alcohol consumption showed a suggestive association with the FI (univariable MR: ß = -0.090; 95% CI = -0.151 to -0.029; p = 0.003; multivariable MR ß = -0.153; 95% CI = -0.212 to -0.094; p = 2.03E-07), with inconsistent results in sensitivity analyses. In complementary analysis, genetic predicted lifetime smoking, but not alcohol use disorder was associated with the FI. There is no convincing evidence for reverse causation. Conclusion: The present MR study supported smoking as a causal risk factor of frailty. Further research is warranted to investigate whether alcohol consumption has a causal role in frailty.

Association between urinary phthalate levels and chronic pain in US adults, 1999-2004: A nationally representative survey.

Introduction: Chronic pain is a public health concern throughout the world. Ascertaining and managing its risk factors helps develop well-directed treatment plans and prevention strategies. Phthalates (PAEs) exposure leads to various health problems. The present study aims to explore the potential correlation between urinary PAEs metabolites and chronic pain in adults. Methods: The study population data were extracted from the National Health and Nutrition Examination Survey (NHANES) conducted from 1999 to 2004 in the United States. Seven urinary PAEs metabolites were used to assess long-term PAEs exposure. The assessment of chronic pain was determined by a self-report questionnaire. Weighted analyses were conducted to consider the complex sampling design. Models were adjusted by demographic data and lifestyle factors. Urinary PAEs metabolites were assessed as both continuous and categorical variables. Tertile 1 was considered as the reference. Stratified analyses were performed by gender and pain site. All data analyses were conducted with STATA, version 15.1. P < 0.05 was considered with statistical significance. Results: A total of 4,196 participants were considered in our final analysis. Chronic pain prevalence reached 52.19% (n = 2,138) among the participants, with women accounting for a large proportion (57.75% vs. 42.25%). After multivariable logistic regression analysis, a higher prevalence of chronic pain was observed among participants in the third tertile of mono-(2-ethyl)-hexyl phthalate (MEHP) (OR = 1.23, 95% CI = 1.02-1.48, P = 0.034) and mono-benzyl phthalate (MBzP) (OR = 1.28, 95% CI = 1.04-1.58, P = 0.022) in our adjusted model. The logtransformed concentration of MBzP also showed a significant association with chronic pain prevalence (OR = 1.09, 95% CI = 1.01-1.18, P = 0.036) in the adjusted model. In further analysis, the positive correlations of urinary phthalate metabolites with chronic pain remained robust when stratified by gender and chronic pain site. Conclusions: Our findings presented a positive correlation between urinary PAEs metabolites and chronic pain among adult participants, and more causal research should be conducted to ascertain the interactions between the two and to expound their underlying mechanisms.

Multisite chronic pain as a causal risk factor for coronary artery disease: findings from Mendelian randomization.

ABSTRACT: The potential consequences of the number of chronic pain sites (referred to multisite chronic pain) on the risk of cardiovascular diseases (CVDs) remain unclear. We attempted to investigate the causality of multisite chronic pain with CVDs and its possible causal mediators. Using summary genome-wide association statistics, two-sample Mendelian randomization (MR) analyses were performed to assess whether multisite chronic pain has a causal effect on the 3 CVDs including coronary artery disease, atrial fibrillation, and stroke. We then conducted MR mediation analyses to establish whether body mass index (BMI), smoking, and depression causally mediate any association. Genetic liability to multisite chronic pain was associated with increased risk of coronary artery disease (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.19-1.95 per one increase in the number of pain locations) but not with atrial fibrillation or stroke. We also found positive causal effects of multisite chronic pain on BMI, smoking, and depression and causal effects of BMI, smoking, and depression on coronary artery disease. In multivariable MR analyses, the excess risk of coronary artery disease was attenuated after adjusting for BMI (OR 1.43, 95% CI 1.05-1.93), smoking (OR 1.49, 95% CI 1.11-2.00), depression (OR 1.44, 95% CI 1.03-2.01), and 3 risk factors combined (OR 1.34, 95% CI 0.88-2.05). Our findings demonstrated that multisite chronic pain led to higher risk of coronary artery disease, which is partly mediated through BMI, smoking, and depression.

Physical activity and risk of gallstone disease: A Mendelian randomization study.

Objective: Given the association between physical activity and the reduced risk of gallstone disease as suggested in observational studies, a Mendelian randomization study was conducted to evaluate the causal nature of this association in genetic epidemiology. Study: Including self-reported and accelerometer-based physical activity traits, the independent genetic variants associated with physical activity were selected from the corresponding genome-wide association studies as instrumental variables. The summary-level data for gallstone disease were sourced from the UK Biobank (7,682 cases and 455,251 non-cases) and FinnGen consortium (23,089 cases and 231,644 non-cases). Then, two-sample Mendelian randomization analysis was conducted. Inverse-variance weight (IVW), weighted median, and Mendelian randomization-Egger regression were determined through Mendelian randomization analyses. To ensure the robustness of the results, sensitivity analyses were also carried out in the study. Results: The negative causality between the genetically predicted accelerometer-based "average acceleration" physical activity and the risk of gallstone disease was suggested in the UK Biobank study (p = 0.023, OR = 0.93, 95% CI: 0.87-0.99), and accelerometer-based "overall activity" physical activity and the risk of gallstone disease in the UK Biobank study (p = 0.017, OR = 0.38, 95% CI: 0.17-0.84). With accelerometer-based "average acceleration" physical activity negatively correlated with gallstone disease in the FinnGen consortium data (p = 0.001, OR = 0.94, 95% CI: 0.90-0.97). As for self-reported moderate-to-vigorous physical activity, however, there was no causality observed in both pieces of data. Conclusion: Our studies provide the evidence suggesting a casual association between physical activities and gallstone disease through analysis of genetic data. As indicated by the research results, there is a possibility that a higher level of physical activities could mitigate the risk of gallstone disease.

Frailty and cardiometabolic diseases: a bidirectional Mendelian randomisation study.

BACKGROUND: Frailty is strongly associated with cardiometabolic diseases in observational studies. However, whether the observed association reflects causality requires clarification. We performed a bidirectional Mendelian randomisation (MR) study to assess the causal relationship of frailty, measured by the frailty index (FI), with coronary artery disease (CAD), stroke and type 2 diabetes (T2D). METHODS: We extracted summary genome-wide association statistics for the FI (N = 175,226), CAD (Ncase = 60,801, Ncontrol = 123,504), stroke (Ncase = 40,585, Ncontrol = 406,111) and T2D (Ncase = 55,005, Ncontrol = 400,308) among individuals of European ancestry. Independent genetic variants associated with each phenotype at the genome-wide significance level were taken as instruments. Two-sample MR analyses were primarily conducted using the inverse-variance-weighted method, followed by various sensitivity and validation analyses. RESULTS: Genetically predicted higher FI was significantly associated with increased risk of CAD (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.17-1.96) and T2D (OR 1.80, 95% CI 1.31-2.47) and suggestively associated with higher risk of stroke (OR 1.36, 95% CI 1.01-1.84). In the reverse direction analysis, genetic liability to CAD (beta 0.037, 95% CI 0.019-0.055), stroke (beta 0.096, 95% CI 0.051-0.141) and T2D (beta 0.047, 95% CI 0.036-0.059) showed significant associations with increased FI. Results were stable across sensitivity and validation analyses. CONCLUSION: Our study strengthened the evidence for a bidirectional causal association between frailty and cardiometabolic diseases. Further understanding of this association will be critical for the optimisation of care in older adults.

Vitamin D Status and Risk of All-Cause and Cause-Specific Mortality in Osteoarthritis Patients: Results from NHANES III and NHANES 2001-2018.

Objectives: The role of Vitamin D (VD) in calcium balance and bone health makes VD a vital factor in osteoarthritis (OA). Studies that have evaluated the effect of VD on OA patients have mainly been performed on a short-term basis. In this analysis, we aimed to evaluate whether VD was associated with mortality, a long-term outcome, in OA patients. Methods: Participants with self-reported OA from NHANES III and NHANES 2001−2018 were included. Associations of 25(OH)D concentrations with mortality risk were assessed continuously using restricted cubic splines and by categories (i.e., <25.0, 25.0−49.9, 50.0−74.9, and ≥75.0 nmol/L) using the Cox regression model. Sensitivity and stratified analyses were performed to evaluate the robustness of the results. Results: A total of 4570 patients were included, of which 1388 died by 31 December 2019. An L-shaped association was observed between 25(OH)D concentrations and all-cause mortality, whereas an inverse association was found for cardiovascular disease (CVD) mortality. The adjusted hazard ratios (95% confidence intervals) across four categories were 1.00 (reference), 0.49 (0.31, 0.75), 0.45 (0.29, 0.68), and 0.43 (0.27, 0.69) for all-cause mortality and 1.00 (reference), 0.28 (0.14, 0.59), 0.25 (0.12, 0.51), and 0.24 (0.11, 0.49) for CVD-specific mortality; no significant associations were found for cancer-specific mortality. Similar results were observed when stratified and sensitivity analyses were performed. Conclusions: Compared with patients with insufficient or deficient serum 25(OH)D, those with sufficient 25(OH)D concentrations had a lower risk of all-cause and CVD mortality, supporting a beneficial role of VD on a long-term basis.

Healthcare Professionals' Views of the Integrated County Healthcare Consortium in Zhejiang, China.

Introduction: The integrated county healthcare consortium (ICHC) is becoming an important measure to improve the capacity of primary-level medical services and to achieve grading diagnosis and treatment system in China. However, it is not clear whether health professionals are satisfied with this reform and what are the problems with it. This study aimed to understand the satisfaction of healthcare professionals to the ICHC in Zhejiang Province, China, and analyze the problems and improvement measures of the ICHC. Methods: A cross-sectional study was carried out in the 11 pilot counties (cities and districts) implementing the construction of the ICHC in Zhejiang in November 2019. Healthcare professionals from the leading county-level hospital, three township health centers (THCs) or community health centers (CHCs) in each ICHC were invited to participate in this survey. Results: A total of 3531 healthcare professionals were included, 85.92% of the participants agreed that the integration of the Centers for Disease Control and Prevention (CDC) and other professional public health institutions into the construction of ICHC could actively promote basic public health work. The most severe problem was the lack of financial guarantee fund input (severity score: 2.92 ± 1.76). The most crucial measure to promote the construction of the ICHC was to increase government financial input and improve the security mechanism (importance score: 4.81 ± 0.47). The satisfaction of the healthcare professionals to the ICHC was 89.41%. The satisfaction of healthcare professionals from county-level hospitals was 2.37 (95% CI: 1.760-3.238) times higher than that of healthcare professionals from the township health centers (THCs) or community health centers (CHCs). The satisfaction of health professionals with a college degree or below was 3.215 (95% CI: 1.413-6.786) times higher than that of health professionals with a master's degree or above. Conclusions: Zhejiang Province has taken adequate measures to promote the construction of the ICHC. However, there are still some problems. Appropriate and effective policies should be implemented to enhance policy coordination and promote competition among ICHCs, as well as to strengthen medical service quality management and improve performance appraisal scheme.

Genetically predicted physical activity is associated with lower serum urate concentrations.

BACKGROUND: Physical activity (PA) is considered to play an important role in the reduced gout risk. However, the epidemiology results are inconsistent and causality remains unclear. OBJECTIVE: To investigate the causal relationship of PA with serum urate concentrations and gout risk by a bidirectional Mendelian randomization (MR) approach. METHOD: Two genome-wide association studies (GWASs) from UK Biobank were used to identify instrumental variables for self-reported moderate-to-vigorous PA (including 377,234 European individuals), accelerometer-measured 'average acceleration' PA (including 91,084 European individuals) and accelerometer-measured overall PA (including 91,105 European individuals). The summary data for serum urate (including 110,347 European individuals) and gout (including 2,115 cases and 67,259 controls) were derived from GWAS of Global Urate Genetics Consortium. Moreover, reverse direction Mendelian randomization study was conducted. The inverse-variance weighted, weighted median, Mendelian randomization Egger regression, simple mode and weighted mode and Mendelian Randomization Pleiotropy RESidual Sum and Outlier were methods we performed. RESULT: Genetic predisposition to accelerometer-measured 'average acceleration' PA [beta = -0.038; 95% confidence interval (CI) = -0.060,-0.015; P = 0.001] and accelerometer-measured overall PA (beta = -0.339; 95% CI = -0.522,-0.156; P = 2.8E-4) were significantly associated with decreased serum urate concentrations. Besides, there was no evidence supporting the causal association between PA and gout risk. In the reverse direction analysis, genetic predisposition to both urate and gout were not associated with PA being investigated. CONCLUSIONS: In MR study, we found that PA may reduce serum urate concentrations but not the risk of gout. Moreover, serum urate concentrations and gout were not associated with PA.

Genetic Correlation and Bidirectional Causal Association Between Type 2 Diabetes and Pulmonary Function.

Background: Observational studies have shown possible bidirectional association between type 2 diabetes (T2D) and pulmonary function, but the causality is not well defined. The purpose of this study is to investigate genetic correlation and causal relationship of T2D and glycemic traits with pulmonary function. Methods: By leveraging summary statistics from large-scale genome-wide association studies, linkage disequilibrium score regression was first implemented to quantify genetic correlations between T2D, glycemic traits, and several spirometry indices. Then both univariable and multivariable Mendelian randomization analyses along with multiple pleiotropy-robust methods were performed in two directions to assess the causal nature of these relationships. Results: Forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) showed significant genetic correlations with T2D and fasting insulin levels and suggestive genetic correlations with fasting glucose and hemoglobin A1c. In Mendelian randomization analyses, genetically predicted higher FEV1 (OR = 0.77; 95% CI = 0.63, 0.94) and FVC (OR = 0.82; 95% CI = 0.68, 0.99) were significantly associated with lower risk of T2D. Conversely, genetic predisposition to higher risk of T2D exhibited strong association with reduced FEV1 (beta = -0.062; 95% CI = -0.100, -0.024) and FEV1 (beta = -0.088; 95% CI = -0.126, -0.050) and increased FEV1/FVC ratio (beta = 0.045; 95% CI = 0.012, 0.078). We also found a suggestive causal effect of fasting glucose on pulmonary function and of pulmonary function on fasting insulin and proinsulin. Conclusions: The present study provided supportive evidence for genetic correlation and bidirectional causal association between T2D and pulmonary function. Further studies are warranted to clarify possible mechanisms related to lung dysfunction and T2D, thus offering a new strategy for the management of the two comorbid diseases.

Association of urinary phthalate metabolites with osteoarthritis in American adults: Results from the national health and nutrition examination survey 2003-2014.

Phthalates have extensive existence in the living environment of human, probably tightly associated with multiple human diseases. The present study aimed to exploratorily investigate the association of urinary phthalate metabolites with osteoarthritis (OA) in American adults by exploiting the data extracted from National Health and Nutrition Examination Survey (NHANES) 2003-2014 with levels of eleven urinary phthalate metabolites as exposure. The multivariable logistic regression models were performed after controlling for urinary creatinine, age, gender, race/ethnicity, education level, marital status, smoking, body mass index, physical activity in recreational time, family poverty income ratio, diabetes, hypertension, as well as survey cycle. Compared with those in the lowest quantile, we observed higher prevalence of OA in the maximal quantile of MCOP (OR = 1.55, 95% CI = 1.06-2.27) in adjusted model. A one-unit increase in log-transformed phthalate metabolites was significantly associated with higher OA prevalence, including MCOP (OR = 1.13, 95% CI = 1.02-1.26) and MBzP (OR = 1.12, 95% CI = 1.00-1.26) in adjusted model. In subgroup analysis, the positive associations between phthalate metabolites and OA prevalence remained robust both in males and females. In brief, this study first presented positive evidence for the association of urinary level of phthalate metabolites with OA prevalence in American adults. Additional causal research is required to confirm the finding from our analysis and elucidate the potential underlying mechanisms of phthalates exposure on OA.

A bibliometric analysis of income and cardiovascular disease: Status, Hotspots, Trends and Outlook.

BACKGROUND: Income is 1 of the socio-economic indicators and could directly influence the health outcomes of cardiovascular disease (CVD). The relationship between income and CVD has attracted more and more scholars' attention in the past 20 years. METHODS: To study the current research dynamics of this field, a bibliometric analysis was conducted to evaluate the publications from 1990 to 2018 based on the Science Citation Index Expanded database. By using the Derwent Date Analyzer software, the following aspects were explored: RESULTS:: The USA ranked first in this field, followed by UK and Canada in terms of number of publications. As for institutions, Harvard University took the leading place in the number of publications, as well as the h-index. Plos One had the most publications and "health" was the most frequent used keyword. The leading research area was "public environmental occupational health". CONCLUSIONS: In conclusion, the elderly, the children and the puerpera were the main study population in this field and "disease prevention" was the main study direction. The most concerned health issues in this field were "obesity" and "diet". There might be a lack of articles that explore the associations between income and CVD with a global perspective. Articles on this content are urgently warranted.

Dental caries and associated factors in 3 to 5-year-old children in Zhejiang Province, China: an epidemiological survey.

BACKGROUND: Dental caries in preschool children is prevalent worldwide, but data regarding its magnitude and associated factors were not available for preschool children in Zhejiang Province, China. This study examines the dental caries situation and its associated factors in Zhejiang Province. METHODS: A total of 1591 children aged 3-5 years and their parents or caregivers were enrolled in this study. The condition of their teeth was assessed by three dental technicians qualified to WHO 2013 criteria. A structured questionnaire was completed by the children's parents or caregivers. A logistic regression analysis was used to analyze the risk factors that may be associated with dental caries occurring among preschool children. RESULTS: Caries prevalence (dmft> 0) of 3-5 year old children in Zhejiang Province was 70.4%. The mean decayed, missing and filled teeth (dmft) scores of the 3, 4 or 5 year old children surveyed were 2.96 ± 4.07, 4.42 ± 4.66, and 5.75 ± 5.19 respectively. The negative binomial regression model found that higher dental caries prevalence was found in children as age increased, with lower body mass index (BMI), with longer breastfeeding duration and with fewer hours of sleep. CONCLUSIONS: The dental caries prevalence and dmft score of 3-5-year-old children in Zhejiang Province was high, and it was associated with age, BMI, breastfeeding duration and hours slept.

Regional health-care inequity in children's survival in Zhejiang Province, China.

BACKGROUND: China is now under a period of social transition, and inequity is evident in the field of health care. We aimed to investigate regional health-care inequalities in children's survival in Zhejiang Province, China. METHODS: In our study, monitoring data of Zhejiang Province from 2005 to 2014 was collected. The flow of data collection of community-district-city for urban areas or village-township-county rural areas was followed. The factors affecting equity was analyzed including regional economical level and household registry. We adopted standard measures of concentration curve and concentration index to evaluate degree of income-related inequity and the trend of mortality changes. RESULTS: From 2005 to 2014, overall mortality rate in children under five decreased, and regional disparity reduced markedly, and with a reduced disparity of mortality rate among children from urban and rural areas. In 2014, the mortality rate in children from urban and rural areas was similar. In contrast, the mortality rate in the children from migrant population was more than two folds of that in the children from native residency (7.82 ‰ vs. 3.89 ‰). The mortality rates of newborns (rs = -0.396, P < 0.001), infants (rs = -0.553, P < 0.001) and children under five (rs = -0.568, P < 0.001) were all negatively correlated with per capita GDP in different regions. CI in the newborns, infants and children under 5 years was -0.105, -0.107 and -0.118, respectively. The concentration curve was near to equity curve. The concentration curve was near to equity curve. The mortality rate of children was negatively related with economical level in this study. CONCLUSIONS: The survival status was near to equity. Regional economical development can improve children's survival but it was not the only social determinant. Migrant population will be the future monitor focus for reducing disparity on healthcare and increase equity in children's survival.

Mortality Rate for Children under 5 Years of Age in Zhejiang Province, China from 1997 to 2012.

OBJECTIVES: This is a population based descriptive study that examined the trends in childhood mortality among under five children and the major causes under five mortality in Zhejiang Province, China. METHODS: A population-based survey was conducted through a province-level surveillance network. The mortality rate and leading causes of death for children under 5 years of age were analyzed. The trend in the mortality rate for children under five and cause-specific mortality rates were analyzed by chi-square with SPSS 13.0 software. RESULTS: In Zhejiang Province, during 1997-2012, mortality rates in neonates, postneonatal infants, and children under 5 years were reduced by 64.2% (from 7.85 to 2.81 per 1000 livebirths), 66.7% (from 12.73 to 4.24 per 1000 livebirths), and 63% (from 15.76 to 5.85 per 1000 livebirths), respectively. The mortality rates in children under 5 years of age decreased by 59.5% (from 11.09 to 4.49 per 1000 livebirths) and 65.8% (from 19.30 to 6.61 per 1000 livebirths) in urban and rural areas, respectively. Prematurity/low birth weight and congenital heart disease were in the top five causes of death in children under 5 years of age during 1997-2012. CONCLUSIONS: Zhejiang province has achieved great progress in the reduction of mortality rates in children under five-years-old during the past two decades. The future tasks on reduction of mortality rate still rely on how to improve the management of premature birth/low birth weight, reduce birth defects and prevent accidental deaths in Zhejiang Province.